Information Based Design - Next Gen Data Warehouses

Recently, in my webinar done jointly with expressor, I was asked a question: "Is the best practice for deploying warehouses a "single, enterprise wide warehouse" or a warehouse with different data marts for each line of business?" My answer was "it depends on the client". Very simply said. As I was talking to a colleague of mine, we knew the answer wasn't that simple and we decided to write a whitepaper about it. So here we are, with a brand new, hot off the press (or Adobe for that matter), FREE whitepaper on "Information Based Design - Next Generation Data Warehouses for Healthcare providers". Here is an excerpt from the whitepaper:

"Very large companies can afford big investments and long lead times to build out new enterprise data warehouse environments. These can be several year projects that cost tens of millions of dollars, or more. Success (based on full achievement of the initial vision) is far from guaranteed. Not uncommonly, after several years, planning for the “next generation” data warehouse begins to take root and the process begins anew… Meta Analytix and End to End solutions present a white paper on Information Based, Incremental, Data Warehouse design for those organizations with limited time and budgets."

Continue to White Paper here: http://www.metaanalytix.com/page.php?page=15

Active vs. Passive Intelligence

During a recent webinar I gave, I was asked about delivering intelligence to the end user. It got me thinking as to what are the best ways to deliver information in the "I have the smallest device I can fit in my eye coolest toy that you don't have" era?

As any good technologist would do, I thought about the different types of users and how they would access information. Then I thought about "what" information they needed. So, in a healthcare informatics setting (after all, that is what we are talking about here), to me, there are two types of users who could benefit from informatics. The Active Intelligence Users and the Passive Intelligence users.

Active Intelligence:

Take an ER doc, for example. She sees a multitude of patients in a single day, works ungodly hours (trust me, I know a few) and probably works in more than one hospital. If you asked her if she is up to date on the latest research in heart conditions (after all, if you have a heart attack, you are not going to your local world renowned cardiologist, you are running to the ER), she would either laugh at you or worse, walk away in a huff, vowing never to speak to you again. Enter the words that we are all familiar with, Clinical Decision Support. This is a form of active intelligence. Delivery of information to the end user ( our heroine in this case ), at the "point of care", where she can quickly browse through the latest guidelines on heart conditions before seeing the patient or fancier still, input patient information directly into her "eyeball wearable device" and the suggestions are automagically transferred to her brain.

Passive Intelligence:

Passive intelligence in much simpler, but not any less important. We have always heard that "history is a good teacher" (whether we listen to history is another question altogether), but for the sake of this blog, let's say history is indeed, a good teacher. Who are the cool customers of this type of intelligence? Your researchers, your administrators and the people who have to run the "business of healthcare".

So, there you have it, two broad categories of intelligence (and I am sure some of you may have thought of umpteen number of other types of intelligences), but that's your problem!

Metadata for Healthcare

In my webinar, I spoke of how expressor helps you manage metadata "in-process" rather than as an afterthought. Dr. David Fenstermacher, Chair and Executive Director of the Department of Biomedical Informatics at the H. Lee Moffitt Cancer Center & Research Institute is giving a webinar on "Metadata, the cornerstone of tomorrow's healthcare information systems", a more detailed dive into the use of metadata. It's Free. You can register for the webinar here:

http://pages.expressor-software.com/metadata-the-cornerstone-for-tomorrows-healthcare-IMS-webinar.html

Meaningful Use - Final Rule - Again!

Ok,

So my sales team twisted my arm to put this on here. So, please bear with me: Here it goes.

By now, you have all read the 864 page meaningful use Final Rule and are prepared to be compliant right? Well, if not, we’d like to talk to you about Compliance Reporting for Meaningful Use.

As you may already know, there are 15 core measures that you have to electronically report to CMS to be compliant. And you may already know that a CCHIT certified EHR alone is not going to help you get there. Let us take a moment to introduce you to Meta Analytix’s comprehensive informatics platform designed specifically for Healthcare, Integra.

As a savvy executive, you already know what Informatics can bring to the table in increasing profitability, improving your organization’s competitiveness in the marketplace and having a single view of your entire organization. Some of the statistics that you may not know are these. Best in class Hospitals that have used centralized business intelligence have achieved:

* Increased profitability from 1%-9% (Aberdeen Research)

* An average of 36 days to receive payment on accounts vs. 46 days for all others (Aberdeen Research)

* A nurse turnover rate of 10% vs. 14% for all others (Aberdeen Research)

Given this scenario, how can we help? Take a look at the salient features of Integra

* Over 400 Healthcare measures pre-loaded, including meaningful use measures

* Enterprise Class ETL platform built in (http://expressor-software.com).

* Can acquire data from your EHR software, SAS, COBOL and others

* Standardized data definitions pre-loaded for Healthcare

* Flex Dimensional^TM Data Model ready for staging and reporting

* Enterprise Open Source BI platform for reporting, drill down analysis and dashboard building.

* Low Total Cost of Ownership (TCO)

* Low implementation lifecycle. (Avoid making costly purchases of individual components and building from scratch)

* Experienced Consultants to work with you to implement your informatics platform seamlessly with minimal workflow interruption

As you can see, Integra is the only informatics platform pre-built for Healthcare and ready to get you to to Meaningful Use in the quickest possible time. For additional information, please see the attached brochure or visit our website: http://www.metaanalytix.com

Contact us for a demo or for your consulting needs:

Phone: 866.611.8595 Ext. 1 or Ext. 2

Email: info@metaanalytix.com

Meaningful Use - Final Rule

The final rule for meaningful use is here, finally! The good news? Number of measures have gone down. The bad news? It is more complex to collect and report. Take for example the following stage 1 measure as defined in the final rule :

"More than 30% of unique patients with at least one medication in their medication list seen by the EP or admitted to the eligible hospital’s or CAH’s inpatient or emergency department

(POS 21 or 23) have at least one medication order entered using CPOE".

Huh? Think about it. What would the measure for this look like? Let's say the measure looks like this: "% of patients seen by EP (Eligible Professional) in Emergency Department or Inpatient with at least one medication order entered using CPOE".

Easy enough? Not so fast, my computer savvy analyst ( yes, you know who you are...usually known as the "data queen" in your organization). Think about the data elements you have to collect.

Let's break down the measure into chunks to better understand it:

1. Number of patients who was seen by an EP (Eligible Professional) - Who are eligible professionals? (We won't go into the definition here, but if you are so inclined, you can read page 358 of the meaningful use rule to find out.) Bottom line for you to make this measure work, you will have to find out the "type of provider". This information is stored where now? In your HR database, I presume?

2. Seen in an Emergency Department or Inpatient facility: Ok, so what happens if a patient was seen both by your ER and then admitted to your Inpatient facility? No matter, we can work around it, by looking at whether the patient was treated by an ER doc before she was sent to inpatient, right? Where is the data for this? Well, the EMR guys should have this info for sure, right?

3. Medications that are on the medication list ordered by CPOE. Well, the EMR guys should have this data too, correct? Great. It's 2 for EMR, one for HR!

4. Hmmmm....what is the fourth element? Do we have all we need? Not yet, data queen. To calculate this measure, you also need to know the total number of patients who were seen and who were ordered medications "without" the use of CPOE. Where is the data for that?!!! Your appointment scheduling system? Maybe your claims system? Doctors' notes?

Final score? Measure - 1. DQ - 0. The point, I am making, is invest in a really good Informatics platform. The measures are not going away and they are getting more complex. Once in place, you, my dear DQ, will be able to pull this data at the click of a button, or better still, program it to run automatically and send a PDF to your boss as an email attachment!

Vendor's view of Meaningful Use

Take a look:

http://www.healthdatamanagement.com/news/meaningful-use-final-rule-vendors-hitech-40645-1.html?ET=healthdatamanagement:e1348:144427a:&st=email&utm_source=editorial&utm_medium=email&utm_campaign=HDM_Daily_072010

Informatics Webinar

So, someone really wanted me to speak about Healthcare Informatics and I complied! Here is the link to the webinar: http://www.expressor-software.com/healthcare-informatics-meta-analytics.htm

Competition

No, I didn't get lost on the golf course and am just finding my way back! A client kept me busy...imagine that! But that is not the reason for this post. The reason for this post is "Competition"! Well, if you abstract to another level, it is about "Goals".

Have I managed to confuse you yet? Well then, read on. Things are about to become clearer. So, as I was talking to a potential client, I approached him with the same questions that have listed out in these blogs. One of them was "Have you defined your measures yet?". But before he answered, he said "Kishore, my biggest problem is competition. I often make 40 cents on the dollar, there are several other clinics who offer the same services we do in the general area and I am losing my shirt. Someone suggested business intelligence as a solution, but I have no idea where to start". As I was listening to him, light bulb went off in my head! Folks, I am going to tell you something that I normally don't tell anyone...I was wrong! See, just then, I realized I had made a big assumption. I had assumed that everyone knew they WHY of informatics. Not so. So, here is step 1. Know your GOALS!

How do you define your goal? Well, you know this better than any consultant you will ever hire. Your goals may be to "Save more money" or "Comply with ARRA" or "Need to improve my quality of care". Once you know your goals for your measures, i.e, what are you going to do with them, you now have a good idea of "What to measure". Now you can define the measures and follow the steps I have outlined in my previous posts. So folks, happy "goaling"! (Is that a new word? Hmmm....need to check it!)

Metadata & Master Data Management

Hmmmm...interesting topic, eh? Why bother? What can I do? How much is it going to cost me?

Well folks, I am going to tell you a secret. This is a secret that we, I mean technologists, have hidden from you for long. Much like the wall street "experts" who are now "fixing" the problems they created in the first place and getting paid for it, we are doing the exact same thing. This is an issue that we created (I mean technologists). Now we have cool technologies like metadata repositories and dictionaries that can give you standardized data definitions across the enterprise, but we'll need you to pay us for the "cool technology" we created to solve "your issues"!

Why bother?
Answer is simple. Have you ever had Gatorade? Yellow, Blue, Orange? Well if you have, you get different "flavors" of the same thing. Same thing with business intelligence. If you want to call something a pot, call it a pot. Don't call it pot in one place, a vessel in another and a container in another place. Unfortunately, the reality is just that. A pot is called a pot in one system, a vessel in another and a container in a third. If you tried to print out the value of a "pot" for your CEO to see, you would have to sit there and explain "well, it is the same thing, but it may be called a container on page 2"! You can imagine the reaction. Enter metadata and masterdata management! We take the pots and the containers and the vessels, call it a pot, make sure the attributes of all three are the same, store it in a dictionary and charge you a couple of millions for it! Sound cool? No?

What can I do?
There are things you can do and not break the bank while doing it. Old fashioned discipline and planning, for example. And you, as the healthcare exec, is in luck! Because, if you are like most companies, you have a clean slate to start with, in terms of informatics. So, with a little bit of planning upfront, you can avoid a lot of costs later. Incorporate metadata/master data management into your informatics initiative early on. In other words, don't build a warehouse without it! Just like you put planning and thought into collecting your measures, think of having standard data definitions across the enterprise. Reach out to folks like SNOMED to see what they are doing. Trust me, your upfront costs will be a drop in the bucket if you have to do it as an afterthought. It will also ensure better data quality as the data won't get into your system without rationalizing with your dictionary first.

So when your buddy from the other hospital is worried about his/her metadata, you can simply say, "we have incorporated that into the "front end" of our process", take a long hard look at the fairway, judge the wind speed and let it rip!

Golf is like Business Intelligence!!

I was at the golf course this past weekend. As I was having a "heart to heart" conversation with the course (ok, it was more like me pleading to the course), I realized how much the game of golf is like investing in BI.

Let's take a look. Golf is unlike other games we play. For example, if you want to play soccer, you'll go get a ball, get 22 of your friends together , find an open space and take four sticks and stick them at the opposite ends for goal posts and you are ready to go. Not with GOLF!

Even before you set foot on the course, you have to buy a set of clubs. ($2000 for a decent set). Balls - $15.00 a dozen, unless you want the soft core max distance "I can fly like a bird" kind.
Tees - $1.50
Gloves - $16.00
Shoes - $150.00
Attire ; $100.00
Lessons (unless of course you want to invest in more balls and be the laughing stock of your buddies) - $500
Round of Golf - $50.00
Your game? - Sketchy at best for the first few rounds.

Now let's look at your BI initiative:
Hardware - Depending on how many you buy, could go upto $150K.
ETL Software (Server licences) - $750K
ETL Software (Developer licenses) - $150K
Database Server license - $100K ( Again, depending on how many you buy, this could go upto $500K)
BI Server License - $60K
BI Developer Licenses - $2K

Now, you have the equipment. Next step? Hire a Golf Pro (Usually known as Big Six consulting firm) to do a gap analysis and come up with a roadmap for implementation - $200K

You can't go golfing without your buddies now, can you? (Well, if you are like me and obsessed with the game of golf, you might just do that.) But I am not talking about us corner case scenarios then, am I? Let's call your buddies your implementation team. Total cost over a period of 8 months of implementation? $1.9 M

So, like the game of Golf, even before you set foot on the course, you have spent about $2M. Then, after the round of golf (implementation period), about $4M. Get the picture? ROI??

What can you do to avoid costly mistakes?
Step1: The first thing to do is to go through the "Measure Everything That Really Impacts Customers (METRIC)" process . Once you have the repository of metrics and have decided how you want to see your data and how often, then you can go to step 2.
Step 2: Prioritize your measures according to business need. Apply the 80/20 rule. Basically, 20% of your metrics should give you 80% of the value.
Step 3: Evaluate technology solutions that fit your need
Step 4: Purchase
Step 5: Implement
Step 6: Test and Deploy

Maximum value can be achieved with a little careful planning upfront. Now, you can go play a good round (and if you are in Jacksonville, call me for that round) of golf knowing that your BI initiative is better than 60% (according to Gartner) of the initiatives out there!

The Biggest mistake some Health IT Executives will make this year

Now that the Interim Final Rule for "Meaningful Use" has been published and the reporting requirements are clearer, what is the biggest mistake one can make this year? Go out there, buy and implement an EHR solution! No, I didn't wake up on the wrong side of the bed this morning. Nor was there any "extra something" in my coffee! Let me explain.
The basic premise of "meaningful use" is to achieve two things.
1. Improve Quality of Care
2. Reduce Cost of Care.

Now, there will be some EHR solutions out there that will satisfy your government mandated reporting requirements. The question is, will that help reduce the cost of care or improve quality of care? The answer is a resounding NO! Why? The EHR solution, web-based or otherwise, is only going to add another silo of data in your organization. It's not going to show you the "correlation" between "Central Line infection rates" and the cost of care. It's not going to show you the correlation between "Average waiting time" and loss of revenue associated with patients leaving without being seen. Nor will it be able to historically report on the "Percentage of patients given smoking cessation counseling" and how that has improved "quality of care".

So, blindly implementing an EHR slution is only going to add another department that you have to manage. Another silo, collecting data, without producing any "meaningful use" for your organization.

So, while you are in the process of evaluating EHR software, consider the TCO and ROI for those investments. Consider how you can leverage the data being generated to add profitability to the business. Consider how you can leverage your existing data and add some "real intelligence" to the business.

Why Informatics?

Now that I am back from a little time off, let's look at the very basic question, Why Informatics? How does this work in healthcare? What are the reasons why I should even think about it? And I am over the subject of the cloud, just so you know.

Savings!!
If you are seriously considering reducing cost of care, the only way to do it is through knowledge. I mean, knowledge of your business. What are my central line infection rates? What is the average waiting time for my patients? What is the average bed occupancy rates? Having answer to these questions and many more will help you produce an effective strategy to make your business more efficient. Efficiency will then translate to savings. We all know that.

Legislation/Compliance!
If you are not already on top of this, please take some time to read through it. You will avoid a lot of heartache down the line. ARRA has some 20 odd measures that you have to report on. With penalties associated with it, if you don't comply. But other than that, when you are looking at an informatics solution, you should probably think ahead to more than just those measures and how implementing a comprehensive solution will affect the bottom line of the business. Also, you could be missing out on the Medicaid funding allocated to provider organizations under the ARRA. $2-$8M allocated for hospitals and $44K allocated for individual physicians. ROI is very evident.

That's about it.